Republicans are trying to change the subject on health care affordability — to transgender care

Republicans in Congress and President Donald Trump are trying to flip the health care script to an issue that’s worked for them in the past: restricting transgender care for children.

On Capitol Hill, lawmakers passed a bill Wednesday to make providing hormones or surgery to transgender children a felony and another Thursday to bar the treatments for children on Medicaid. Health Secretary Robert F. Kennedy Jr. and his advisers announced a slew of rules that would effectively end gender-affirming care at hospitals. In the states, GOP candidates are running ads again condemning Democrats for supporting the care — as Trump did successfully in his 2024 campaign.

With the next election less than a year away, the strategy makes good sense, said Joel White, a former House GOP aide now in the lobbying sector: “The midterm is all about getting your base out. To the extent that there is a divide across the parties on this issue, it helps Republicans.”

Besides winning elections, Republicans believe they’re doing right by kids they think are harmed by hormones and surgeries that transgender people sometimes seek to align their bodies with their gender identity.

“These procedures will fall in the deepest abyss of the dark periods of American history like the lobotomies represent today,” said Mehmet Oz, the former TV doctor who now runs Medicaid for Kennedy, in announcing the rule changes Thursday. “They should be a deeply historic relic that brings shame.”

U.S. medical associations, including the American Academy of Pediatrics and the American Medical Association, disagree. They support gender-affirming care for adolescents and say doctors are more likely to recommend counseling, social transitioning and hormone replacement therapy than surgery.

The GOP push comes as Republicans are struggling to find a message on health care affordability, which polls, including POLITICO’s, have found is a leading concern for voters going into the election year. Insurance is about to get more expensive for millions because subsidies Democrats increased in 2021 for Obamacare coverage are slated to expire on Dec. 31. The vast majority of Republicans oppose an extension, but moderates among them are deeply worried it could cost them their seats.

Opposing transgender care, by contrast, mostly unites Republicans and they think their position appeals to voters. Trump’s most famous ad of his 2024 campaign targeted his Democratic opponent’s support for the care. Only four GOP representatives opposed House legislation by Georgia’s Marjorie Taylor Greene on Wednesday that would make it a felony to provide the care to kids. Republicans were unanimous in backing Texas Rep. Dan Crenshaw’s bill to bar Medicaid funding. Neither has the votes to pass in the Senate, where bipartisan support is required.

A peer-reviewed research letter published by JAMA Pediatrics earlier this year suggested that relatively few kids, about 18,000 as of 2022, would be affected, with less than 1,000 having used drugs that block puberty to prevent physical changes that don’t align with their gender identity. An estimate this year from UCLA’s Williams Institute, relying on Centers for Disease Control and Prevention data covering 2021-2023, said about 724,000 American teenagers under 18 identify as transgender, about 3 percent of the total.

The VIP section at the health department announcement Thursday brought together a cross-section of GOP lawmakers. There were Republicans on the right, such as Crenshaw and Kansas Sen. Roger Marshall, who has set up a Make America Healthy Again Caucus to promote Kennedy’s agenda on Capitol Hill.

The chair of the Senate health committee, Louisiana Republican Bill Cassidy, was there. Up for reelection this year, he’s stressed his agreement with Trump in opposing gender-affirming care at the same time he’s criticized administration policy on vaccines. He took his seat near Texas Attorney General Ken Paxton, the hard-right challenger to GOP Sen. John Cornyn.

Kennedy opened the event by saying that doctors’ associations have betrayed Americans by endorsing transgender care, and his advisers framed gender identity as a cultural brainwashing by the left.

“Men are men. Men can never become women,” said Kennedy’s deputy, Jim O’Neill. “Children are innocent, and they need our protection.”

Oz’s agency, the Centers for Medicare and Medicaid Services, issued two rules to ban the use of Medicaid funds for the treatments and to bar hospitals from receiving Medicare and Medicaid dollars altogether if they offer the care to kids.

Some states currently require their state Medicaid programs to cover gender-affirming care, while about half have already restricted or banned the treatments for kids. Medicaid is a joint federal-state program for low-income people.

In addition to those rule changes, the Food and Drug Administration is warning manufacturers of breast binders, which transgender men and boys use to flatten their chests, not to market the products to transitioning children. HHS will also no longer classify gender dysphoria, the feeling of discomfort or distress some transgender people experience when their bodies don’t align with their gender, as a disability. Finally, the department will issue a public health notice to parents that hormones that help transgender people align their appearance with their gender are not a safe and effective treatment.

Republicans have already seized on transgender issues in a handful of high-profile races ahead of the midterms, while GOP candidates running in competitive primaries in deep-red areas have sought to position themselves as most ardent on the issue.

In Georgia, the GOP leadership-aligned group One Nation spent $350,000 in April on an ad targeting Sen. Jon Ossoff, a Democrat and one of Republicans’ top targets, over his vote against a bill that would have prevented youth assigned male at birth from participating in girls or women’s sports, according to data from AdImpact, which tracks political advertising. Rep. Buddy Carter, one of several Republicans aiming to challenge Ossoff, has similarly spent more than $500,000 on TV ads that mention transgender issues.

The GOP’s Senate campaign arm has honed in on the topic. They’ve called out Democrats in the key battlegrounds of North Carolina, Maine and Minnesota for supporting transgender rights.

“These are the candidates Democrats are putting front and center after voters rejected Democrats’ radical transgender ideology in 2024, and they’re going to be held accountable for it again,” said Joanna Rodriguez, a National Republican Senatorial Committee spokeswoman, in a statement.

In Oklahoma, several GOP candidates vying to replace Republican Gov. Kevin Stitt have clashed over transgender issues ahead of next year’s primary. After former state house Speaker Charles McCall, a Republican, faced an attack ad from an outside super PAC that called him a transgender ally, McCall released an ad of his own declaring that “cutting a banana does not make it an orange” and highlighting his work in the legislature to ban transgender surgeries for minors. A majority of TV ad spending in the governor’s race so far has been on ads that mention transgender issues, according to AdImpact data.

White, who is a partner at Monument Advocacy, said that the heated debate over Affordable Care Act subsidies may have also reignited the party’s desire to rein in taxpayer-funded transgender care.

“It’s been linked to the ACA subsidies, it’s been linked to Medicaid, it’s been linked to Medicare,” White said of gender-affirming care. “As a matter of policy, should taxpayers finance these procedures?”

Now the Trump administration’s health leaders are also leaning in. Marty Makary, the FDA commissioner, suggested in some high schools more than half of students identify as nonbinary. Kennedy accused doctors’ associations of breaking the Hippocratic oath, in which they pledge to do no harm, after their endorsement of transgender care.

If the proposed CMS rules are finalized, it would effectively shut down hospitals that continue to offer gender-affirming care, given their financial reliance on patients insured by the government programs.

According to the department, the measures make good on an executive order Trump signed back in January.

Democrats said they saw the push on transgender policy as a cruel bid to change the subject that substitutes Republicans’ opinions about the care for that of doctors and families.

Rep. Jim McGovern (D-Mass.) blasted Greene’s and Crenshaw’s bills as “nonsense” during a Rules Committee meeting on Tuesday. “The transgender community is not responsible for health care costs rising. Republicans are,” he said.

Moderate Reps. Mike Lawler (R-N.Y.) and Brian Fitzpatrick (R-Pa.) — who also broke with their party to force a vote on extending the Obamacare subsidies — opposed Greene’s bill, along with Gabe Evans of Colorado and Mike Kennedy of Utah, while Democrats in south Texas, Henry Cuellar and Vicente Gonzalez, and Don Davis of North Carolina, joined most Republicans in supporting it.

The same three Democrats, along with Washington Rep. Marie Gluesenkamp Perez, voted for Crenshaw’s bill to restrict Medicaid funding.

Advocates for transgender people said the GOP moves will just hurt vulnerable children.

“The harms of these ideas and the threats to care have been so clear and so pronounced among patients,” said Scott Leibowitz, a child psychiatrist and board member of WPATH, a medical group that recommends standards for the care.

Kelley Robinson, the president of the Human Rights Campaign, the LGBTQ+ rights organization, said in a statement that Trump’s policies would “completely cut off medically necessary care from children.”